Bringing close others to the emergency department for an acute coronary event is associated with increased patient perception of threat

Abstract

Objective: Relationship quality is one of the most consistent psychosocial predictors of physical and mental health. Yet, little research examines relationship types or support within the immediate context of acute health events. We tested the unexplored role that close others play in patients’ experience of threat during evaluation for acute coronary syndrome (ACS) in the Emergency Department (ED), as well as the indirect effect of close others on ACS-induced posttraumatic stress disorder (PTSD). Method: Participants were 871 patients evaluated for ACS at an urban academic ED (60.86 years old; 54.08% male; 56.37% Hispanic, 19.86% Black, 16.65% White). Threat perceptions were assessed in-ED and median 3 days later. ACS-induced PTSD was assessed median 41 days later using the PTSD checklist cued to a specific stressor. Non-overlapping categories representing close others in the ED (i.e., spouse/significant other, child), non-close others (e.g., neighbor), or no one. Results: Patients who brought close others recalled experiencing greater threat in the ED: vs. no one, b = 0.11, p = .072; vs. non-close others, b = 0.16, p = .030. There was no direct effect of close others on ACS-induced PTSD; however, recalled threat mediated the effect of close others on development of ACS-induced PTSD, ps < .05. Conclusions: Close others were associated with recalling greater threat during ED evaluation, which predicted ACS-induced PTSD. ACS-induced PTSD is associated with medication nonadherence, event recurrence, and mortality, highlighting the need to develop a greater understanding of the impact stressful medical environments have on patients and close others.

Early Exposure to Cardiac Treatment and Distress Among Patients and Their Caregiving Partners

“…Emerging research has begun to illuminate the potential for negative psychological effects in patients who have a close other, such as a spouse or romantic partner, present during early emergency care. For example, one study conducted at an urban medical center in the United States found that patients in the ED with close others reported feeling more threatened, helpless, and vulnerable when asked to recall their ED experience only a few days later (Cornelius et al, 2019a). There was no impact of the presence of a partner on patient anxiety in the current study, however.…”

“…We hypothesized the link between partner presence and partner PSS because presence can be seen as similar to trauma exposure (Vilchinsky, 2017;Vilchinsky and Dekel, 2018). However, since in a prior study, we did not find evidence for a direct effect of close others on distress distal to an acute coronary syndrome (ACS) in patients (Cornelius et al, 2019a), we refrained from hypothesizing the same link for patients. We anticipated that partners who were not at all exposed to the event would be the least distressed.…”

“…One context in which social support is thought to be beneficial is emergency health situations (United Hospital Fund, 2012), for example, having a support person present during a life-threatening event such as acute coronary event (e.g., acute coronary syndrome, cardiac arrest). Yet, recent research suggests that close others in an emergency context may actually cause distress in patients (Cornelius et al, 2019a), and some who accompany patients to the emergency department (ED) are ill-equipped to provide social support (Homma et al, 2016). A possible explanation for this may be that an acute coronary event is also incredibly distressing to partners.…”

“…The experience of an acute coronary event, including early care and evaluation, can be a distressing and traumatic experience for patients and romantic partners alike. A new line of research suggests that close others in the ED, such as a spouse or romantic partner, may actually cause patients distress when contrasted to patients who arrive with non-close others (e.g., a neighbor) or alone (Cornelius et al, 2019a). Although the reasons for this remain unclear, partner distress may exacerbate the already-stressful emergency care environment.…”

Dyadic disruption theory

“…An acutely life‐threatening medical event may represent a highly sensitive window in which novel health behaviors are initiated and the transition to established patterns of chronic illness management begins (or changes to prior management behaviors are necessitated). Early distress can also develop within each member of the dyad, which may undermine the benefits of relationships for patient health and well‐being (Cornelius, Derby, et al., 2020; Cornelius, et al., 2019). Distress also undermines the initiation of health behaviors for secondary prevention (e.g., physical activity, medication adherence), which has long‐term implications for physical health (Cornelius, Agarwal et al., 2018; Edmondson, Horowitz et al., 2013; Edmondson et al., 2012; Edmondson, Richardson et al., 2013; Fait et al., 2017; Kronish et al., 2014, 2006; Vilchinsky, 2017).…”